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In conclusion, the use of homework as a component of CBT with older adults can be very effective in supporting the therapeutic process, developing coping skills, and preventing relapse of symptoms. Traditional CBT techniques (thought records, mood monitoring, relapse prevention planning, etc.) are appropriate to use with older clients. To be most effective, homework should be assigned in the context of a strong therapeutic relationship and with a link being established between the goals of therapy and how the homework might help the client achieve those therapeutic goals. Homework should be explained as specifically and clearly as possible, be adapted to the realities of the client’s life situation, and when completed, be reinforced. Problem solving around lack of compliance with homework will also increase the likelihood that the client will engage in homework. When these accommodations are in place, older adults will be very likely to comply with and benefit from the homework associated with their therapy.

Homework is an important component of many approaches to couple therapy and an integral part of cognitive-behavioral couple therapy. It extends the impact of therapy into the couple’s daily life and allows them to implement changes in their relationship under the more complex and challenging conditions of the home environment and other aspects of real life. Feedback that the couples give the therapist about their successes and failures with homework assignments is crucial information about ways that therapeutic interventions need to be tailored to the needs of each couple. The success of homework tasks depends on multiple factors concerning the characteristics of the tasks, how the therapist relates to the members of the couple and presents homework goals and methods, and characteristics of the members of the couple such as their goals for their relationship, attitudes about input from outsiders, degree of motivation to take personal responsibility for relationship problems and their solutions, and their comfort with proposed changes in the relationship. Therapists and couples can use homework as a major resource in achieving progress.

Families presenting to treatment hope to learn strategies and skills to improve their functioning. Homework is one essential tool family therapists use to support these strivings. While therapists select homework assignments based on the targets of the intervention, the same kind of core family processes are ultimately involved, such as strengthening communication and problem solving, nurturing attachment, building family structure, and shaping appropriate reinforcement contingencies. Issues related to treatment engagement, therapeutic alliance, homework acceptance, and the vicissitudes of family life are potential barriers to the successful use of homework in family therapy. Finally strategies that engage family members, that promote positive therapist-family member interactions, and that consider task difficulty in the context of the family system contribute to successful homework use in treatment.

As these two case studies illustrate, homework is absolutely essential to the effective use of CBT in the treatment of eating disorders and in the prevention of relapse. Adherence to homework assignments, including difficult assignments that provoke anxiety, is best achieved in the context of a strong relationship in which clients understand the rationale for the assignment and are able to articulate in their own words how the assignment may help them. Research should help develop ever more effective homework assignments and ever more effective means of enhancing adherence to help patients recover and stay well.

This chapter has outlined a cognitive model of low self-esteem and a cognitive-behavioral treatment program based upon it. It has considered the value of independent self-help assignments (homework) at each stage in therapy, and concluded by identifying practical issues that need to be taken into account when working to enhance self-esteem. Our overall aim in working with clients who do not value themselves is to help them to create more realistic and flexible standards for themselves, and to establish a stance that acknowledges inevitable human weakness and frailty without condemning it, and without losing a fundamental underlying sense of self-acceptance. Homework is central to this endeavor, because it means that new learning escapes the confines of the consulting room and finds opportunities to flourish in the real world.

OCD is a chronic and potentially debilitating anxiety disorder that can be particularly challenging to treat because of its heterogeneous and idiosyncratic symptom presentation. Although the behavioral treatment known as exposure and response prevention is the most effective psychological intervention for the disorder, a more cognitive understanding and treatment of obsessions and compulsions offers new insights and treatment possibilities for those who have not shown a satisfactory response to ERP. This chapter presented the new CBT approach to OCD. Homework assignments were described that target dysfunctional OCD beliefs of overestimated threat, thought-action fusion, inflated responsibility, overimportance of thought, control, intolerance of uncertainty and perfectionism. Various complications were noted that can arise when assigning homework to obsessional clients. The chapter concluded with a case illustration of the use of homework in CBT for obsessional ruminations. A consistent message throughout this chapter is that homework assignments are critical to the effectiveness of ERP or CBT in reducing obsessions and compulsions, maintaining treatment gains, and preventing relapse.

Homework is an integral part of cognitive therapy for psychosis, and it is, therefore, important to ensure that patients (and therapists) are aware of the need for work to be conducted between sessions. Homework should be agreed collaboratively between therapist and patient, and can involve collecting information, experimenting or practising skills. There are many factors that can increase the likelihood of a patient attempting their homework, such as motivation, addressing memory problems, ensuring an appropriate level of difficulty and the relevance of assignments to problems and providing a coherent rationale. It is also important to allocate sufficient time and effort to addressing such factors within therapy sessions.